Quantitative analysis of the variation in angles of the carpal arch after open and endoscopic carpal tunnel release

Clinical article

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Object

Previous studies have demonstrated that the volume of the carpal canal increases after open and endoscopic surgery in patients with carpal tunnel syndrome. There is some controversy regarding the contribution of the postoperative widening of the carpal arch to the increment in carpal canal volume. The objectives of this study were to: 1) evaluate the degree of variation in the angles formed by the borders of the carpal arch following the surgical division of the transverse carpal ligament; and 2) determine if there are differences in the variation of these angles after the classical open surgery versus endoscopic carpal tunnel release.

Methods

The authors prospectively studied 20 patients undergoing carpal tunnel syndrome surgery: 10 patients were treated via the standard open technique, and 10 underwent endoscopic carpal tunnel release. The angles of the carpal arch were measured on CT scans of the affected hand obtained before and immediately after the surgical procedures. Measurements were performed at the level of the pisiform-scaphoid hiatus and at the level of the hook of the hamate-trapezium hiatus.

Results

There was widening of the postoperative angles of the carpal arch after open and endoscopic division of the flexor retinaculum; however, the difference between pre- and postoperative angulations reached statistical significance only in those patients treated by means of the open procedure. The mean (± SD) values for the postoperative increase in the angles at the level of the pisiform-scaphoid hiatus were 5.1 ± 0.4° after open surgery and 2.5 ± 0.3° after the endoscopically assisted procedure (p < 0.05). At the level of the hook of the hamate-trapezium hiatus, the mean values for the widening of the angles were 6.2 ± 0.6° for the open surgery group and 1.2 ± 0.4° for those patients treated by means of the endoscopic technique (p < 0.05).

Conclusions

The widening of the postoperative angles of the carpal arch is a phenomenon observed at the proximal and distal levels of the carpal canal, and it can be noted after both open and endoscopically assisted carpal tunnel release. The endoscopic procedure yielded less increase in these angles than the open surgery.

Abbreviations used in this paper: CTS = carpal tunnel syndrome; TCL = transverse carpal ligament.
Article Information

Contributor Notes

Address correspondence to: Leandro Pretto Flores, M.D., SQN 208 Bloco F Apartamento 604, Asa Norte Brasília Distrito Federal, Brazil 70853-060. email: leandroprettoflores@hotmail.com.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Ablove RHPeimer CADiao EOliverio RKuhn JP: Morphologic changes following endoscopic and two-portal subcutaneous carpal tunnel release. J Hand Surg [Am] 19:8218281994

    • Search Google Scholar
    • Export Citation
  • 2

    Agee JMPeimer CAPyrek JDWalsh WE: Endoscopic carpal tunnel release: a prospective study of complications and surgical experience. J Hand Surg [Am] 20:1651711995

    • Search Google Scholar
    • Export Citation
  • 3

    Brooks JJSchiller JRAllen SDAkelmam E: Biomechanical and anatomical consequences of carpal tunnel release. Clin Biomech (Bristol Avon) 18:6856932003

    • Search Google Scholar
    • Export Citation
  • 4

    Chow JCHantes ME: Endoscopic carpal tunnel release: thirteen years' experience with Chow technique. J Hand Surg [Am] 27:101110182002

    • Search Google Scholar
    • Export Citation
  • 5

    Cobb TKDalley BKPosteraro RHLewis RC: Anatomy of the flexor retinaculum. J Hand Surg [Am] 18:91991993

  • 6

    Einhorn NLeddy JP: Pitfalls of the endoscopic carpal tunnel release. Orthop Clin North Am 27:3733801996

  • 7

    Garcia-Elias MSanchez-Freijo JMSalo JMLluch AL: Dynamic changes of the transverse carpal arch during flexion-extension of the wrist: effects of sectioning the transverse carpal ligament. J Hand Surg [Am] 17:101710191992

    • Search Google Scholar
    • Export Citation
  • 8

    Gartsman GMKovach JCCrouch CCNoble PCBennett JB: Carpal arch alteration after carpal tunnel release. J Hand Surg [Am] 11:3723741986

    • Search Google Scholar
    • Export Citation
  • 9

    Goldfarb CAKiefhaber TRStern PJBielecki DK: The relationship between basal joint arthritis and carpal tunnel syndrome: an MRI pilot study. J Hand Surg [Am] 28:21272003

    • Search Google Scholar
    • Export Citation
  • 10

    Kato TKuroshima NOkutsu INinomiya S: Effects of endoscopic release of the transverse carpal ligament on carpal canal volume. J Hand Surg [Am] 19:4164191994

    • Search Google Scholar
    • Export Citation
  • 11

    Klein RDKotsis SVChung KC: Open carpal tunnel release using a 1-centimeter incision: technique and outcomes for 104 patients. Plast Reconstr Surg 111:161616222003

    • Search Google Scholar
    • Export Citation
  • 12

    Kretschmer TAntoniadis GBorm WRichter HP: [Pitfalls of endoscopic carpal tunnel release. Part 2: conclusions from findings of open surgery.]. Chirurg 4:2342372004. (Ger)

    • Search Google Scholar
    • Export Citation
  • 13

    Ludlow KSMerla JLCox JAHurst LN: Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature. J Hand Ther 10:2772821997

    • Search Google Scholar
    • Export Citation
  • 14

    MacDermid JCRichards RSRoth JHRoss DCKing GC: Endoscopic versus open carpal tunnel release: a randomized trial. J Hand Surg [Am] 28:4754802003

    • Search Google Scholar
    • Export Citation
  • 15

    Phalen GS: The carpal tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am 48:2112281966

    • Search Google Scholar
    • Export Citation
  • 16

    Prick JJBlaauw GVredeveld JWOosterloo SJ: Results of the carpal tunnel release. Eur J Neurol 10:7337362003

  • 17

    Richman JAGelberman RHRydevik BLHajek PCBraun RMGylys-Morin VM: Carpal tunnel syndrome: morphologic changes after release of the transverse carpal ligament. J Hand Surg [Am] 14:8528571989

    • Search Google Scholar
    • Export Citation
  • 18

    Richman JAGelberman RHRydevik BLHajek PCGylys-Morin VMSartoris DJ: Carpal tunnel volume determination by magnetic resonance imaging three-dimensional reconstruction. J Hand Surg [Am] 12:7127171987

    • Search Google Scholar
    • Export Citation
  • 19

    Schmitt RLucas DBuhmann SLanz USchindler G: [Morphometry using computerized tomography of the wrist in idiopathic carpal tunnel syndrome. Comparison of pre- and postoperative findings.]. Handchir Mikrochir Plast Chir 20:41461988. (Ger)

    • Search Google Scholar
    • Export Citation
  • 20

    Seradge HSeradge E: Piso-triquetral pain syndrome after carpal tunnel release. J Hand Surg [Am] 14:8588621989

  • 21

    Tanabe TOkutsu I: An anatomical study of the palmar ligamentous structures of the carpal canal. J Hand Surg [Br] 22:7547571997

  • 22

    Thoma AVeltri KHaines TDuku E: A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression. Plast Reconstr Surg 114:113711462004

    • Search Google Scholar
    • Export Citation
  • 23

    Viegas SFPollard AKaminksi K: Carpal arch alteration and related clinical status after endoscopic carpal tunnel release. J Hand Surg [Am] 17:101210161992

    • Search Google Scholar
    • Export Citation
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